Synovectomy of the wrist in monoarticular rheumatoid arthritis

Wrist synovectomy (with or without resection of the distal ulna) was performed in 8 cases with monoarticular rheumatoid arthritis affected in the wrist joint. 5 cases (3 female and 2 male) were followed and their mean age was 50 years old. At follow-up after a mean observation time of 26 months, all cases had complete pain relief, but the range of motion was not improved in pronation and in volar flexion. Four cases had morning stiffness preoperatively and it disappeared in all cases. The CRP test was various in each case. The radiographic findings showed progression in all cases. Rheumatoid arthritis developed in the course of the follow-up periods in 3 cases. To diagnose the RA, synovial histology should show the characteristic histological changes in synovial membrane as follows; 1) villous hypertrophy; 2) infiltration of chronic inflammatory cells; 3) tendency to form “lymphoid nodules”; 4) deposition of compact fibrin; and 5) foci of cell necrosis. And 4 cases had 3 or more findings of the above-mentioned. The diagnosis of the monoarticular rheumatoid arthritis is difficult in early stage. Wrist synovectomy and synovial histology is very effective for the diagnosis and treatment of this disease.